Payer Compliance Specialist I

This is a fully remote position, open to applicants in United States.

📋 Description

• Adhere to payer compliance management standard operating procedures.

• Review, assess, and confirm payer under- and over-allowable variances within work queues.

• Oversee corrective measures through appeals, cross-workflow actions, or escalation to management.

• Collect appeal documentation and submit appeals to payers.

• Follow up on appeal outcomes 45–60 days post-submission.

• Collaborate with leadership to investigate and report systemic payer issues leading to variance trends.

• Utilize the out-of-model guidance matrix to inform leadership and finance of over-allowed variances.

• Acquire knowledge of payer policies and contractual agreements.

• Investigate and address refund requests, taking necessary actions.

• Consult with leadership and contract management regarding potential discrepancies in contract terms.

• Maintain regular communication with management concerning payer variance matters.

• Engage with internal RCM departments and insurance providers.

• Identify and rectify payer issues that adversely affect receivables.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• At least 2 years of experience in healthcare revenue cycle is required.

• Proficiency in Excel and Word is essential.

• Basic understanding of managed care programs and healthcare billing requirements is necessary.

• Strong analytical skills to pinpoint and address underpayments related to specific payers and coding issues.

• Solid mathematical, verbal, and written communication skills are essential.

• Experience in gathering and reporting data is expected.

• A collaborative attitude and effective interpersonal skills are important.

• Ability to work autonomously with minimal supervision is required.

• Familiarity with basic medical terminology and concepts is preferred.

• Understanding of CPT, ICD-9, and ASA coding is preferred.

• Must be capable of meeting the physical demands of the position, with or without reasonable accommodation.

• Effective verbal and written communication skills are required.

• Candidates residing in California, Hawaii, or Alaska will not be considered for hiring.

🏝️ Benefits

• Eligibility for quarterly bonuses.

• Commitment to equal employment opportunities.

• Provision of reasonable accommodations for individuals with disabilities.